Influence of histamine release on postoperative vomiting (POV) following gynaecological laparoscopic surgery.
Keywords
Abstract
OBJECTIVE
The mechanisms leading to the high incidence of postoperative vomiting (POV) after gynaecological laparoscopic surgery are still unknown. The effectiveness of POV-prophylaxis using H1 + H2-receptor antagonists has been demonstrated, suggesting a role for histamine in the pathogenesis of POV. However, histamine levels were not measured in these studies. The aim of this study was to investigate the incidence of plasma histamine release and its association with POV after gynaecological laparoscopic surgery.
METHODS
Twenty-two female patients, aged 20-56 y, classified ASA physical status I or II, undergoing elective gynaecological laparoscopic surgery were enrolled in the study. Blood samples for plasma histamine measurements were drawn at defined time points perioperatively. Emetic symptoms were recorded within the first 24 h after operation. A standardized balanced anaesthesia without any prophylactic antiemetic medication was applied. Formal causality analysis for histamine as a determinant for POV was performed.
RESULTS
The overall incidence of POV was 40.9% (9 out of 22 patients). Twelve out of 22 patients (54.5%) demonstrated a histamine release reaction during the whole observation period. Six out of 9 patients with POV (66.7%) had a histamine release. There was no difference in mean plasma histamine levels between POV-positive and POV-negative patients. The conditional probability for POV with histamine release was 6/12 = 0.5, in contrast to 3/10 = 0.3 for POV without histamine release.
CONCLUSIONS
A high incidence of plasma histamine release was demonstrated in most but not all patients with POV. The probability of POV with histamine release (0.5) was higher than without histamine release (0.3), thus histamine release was shown to be one of the contributory determinants for POV in this clinical study. Thus, patients at risk for POV may benefit from a H1 + H2-receptor antagonists prophylaxis alone or in combination with other antiemetic strategies.
